Managing other physical changes

It’s important not to push through pain during sex. This can often make things worse. In the female body, pelvic or abdominal surgery, radiation therapy or treatment that affects hormones can make the vagina smaller or less moist, which can make intercourse painful.

Some people experience vaginismus, where the vagina muscles tighten during or before penetration. This is an unconscious reaction, often caused by fear that intercourse will be painful. Vulvodynia is another condition that causes pain or a burning feeling along vaginal walls during sexual intercourse, often due to dryness or other side effects from treatments. Ask your health care team for a referral to a qualified pelvic health physiotherapist. They can teach you ways to relax your muscles during intercourse.

Scar tissue in the penis after surgery can cause pain or bleeding, but these usually settle down in time. Surgery or radiation therapy can irritate the prostate or urethra, which can cause painful orgasms. Anal sex can be painful after radiation treatment for prostate or anal cancer. Consider other ways to be intimate, such as oral sex.

Managing pain during sex

• Plan sex for the time of day when you have the least amount of pain. If you are using pain medicine, take it about an hour before sex so it has time to work
• Try different positions (such as lying side by side) to find one that may be more comfortable for both of you and puts less pressure on painful areas.
• Use pillows or cushions to help support your body and reduce pressure on sore areas.
• Try relaxation techniques or have a warm bath or massage before having sex.
• If pain continues, ask your doctor for a referral to a specialist pain clinic. Treating pain early and using a holistic approach can lead to better long-term results.
• Listen to Cancer Council's podcast episode Managing Cancer Pain.

Making penetrative sex more comfortable

• Avoid deep pelvic thrusts. Choose positions where you can control the depth of penetration.
• Use plenty of lubricant. A water-based lubricant is easier to wash off but a silicone-based one will last longer. Ask your health care team which one is best for you.
• Try to be close to orgasm or very aroused before penetration.
• A women’s pelvic health physiotherapist can give you advice on using vaginal dilators and pelvic floor exercises to help with pain during intercourse. Using vaginal dilators can be challenging, but they may help over time.
• Ask an occupational therapist what products can help with positioning during sex – they may suggest wedges, pillows, electric beds or transfer boards.

To find your pelvic floor muscles, try stopping your flow of urine for a couple of seconds while emptying your bladder. You use your pelvic floor muscles to do this. You need to do pelvic floor exercises several times a day. The technique is the same for males and females.

Female

Male

1. First, relax all of your pelvic floor and belly or stomach (abdominal) muscles.
2. Gently lift your pelvic floor muscles up and hold while you continue breathing normally. Keep your upper abdominal muscles relaxed. Try to hold the contraction for up to 10 seconds. Relax your muscles slowly after each hold.
3. Repeat this exercise up to 10 times. Rest for 10–20 seconds between contractions. Relax your pelvic floor muscles completely during the rest periods.

If you had a breast, penis or testicle removed, you may choose to use a prosthesis to improve your self-esteem. This is a personal decision and not something everyone wants. Your doctor can explain your options and what the procedure involves. 

If you are worried about how the breast area looks, you may consider nipple tattooing. This can create the colour and shape of a nipple.

Any type of tumour in the brain and its treatment can have an effect on your sex life and intimacy. Many people only think about the sexual side effects when cancer directly involves the genital organs, but the brain is important for sexual arousal.

Some areas of the brain are especially important for sexual function. These include the frontal, temporal and parietal lobes, and pituitary gland. When these are affected, it can cause changes in behaviour, thinking and memory, personality and social skills.